General Surgery Coding Alert

Question: Can we separately bill mesh placement using code +49568 for hernia repairs?

Indiana Subscriber

Answer: You should report code +49568 (Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair)) in only limited hernia repair cases.

Specifically, reserve +49568 for reporting documented mesh insertion in addition to open hernia repair codes 49560-49561 (Repair initial incisional or ventral hernia …) and 49565-49566 (Repair recurrent incisional or ventral hernia …).

The +49568 code definition itself states that it is for use with “open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection.” Then CPT^® adds a text note following the code that states, “use 49658 in conjunction with 11004-11006, 49560-49566.”

Further, the CPT^® introduction to the hernia repair section states, “With the exception of the incisional hernia repairs (see 49560-49566) the use of mesh or other prostheses is not separately reported.”

That means you should not separately report +49568 in addition to open hernia repair codes 49491-49557 and 49570-49590, or laparoscopic hernia repair codes 49650-49657, even if the surgeon documents using mesh.